NHS – Envy of the world or Stalinist Rationer of Healthcare?

NHS: Yes, of course, let me look into that for you. Oh dear. Your course of treatment will cost £3,000. The NHS rations what treatments are available and unfortunately we’ve decided your treatment isn’t covered.

Patient: OK. Well, I’ve just totted up what I paid in tax last year – income tax, national insurance, VAT, tax on my house and car insurance, petrol duty, flight duty, electricity and gas tax, beer and wine tax – it came to £25,000. That’s the average household tax bill. So I’ve paid my share. Can I have the treatment I need now?

NHS: No.

Patient: But a third of government spending is on the NHS, so that means my household has paid over £8,000 into the NHS in one year, and you’re telling me I can’t have treatment that costs £3,000?

NHS: That’s about the size of it, yes. You should be grateful, you know. The NHS is the envy of the world. No other country on the planet has anything as good as our NHS.

Patient: Isn’t that “envy of the world” attitude a bit “Little Englander”?

NHS: No need for hate speech. Look, I’d like to help, but I’m only obeying orders. The system must come first. If we gave you the treatment we’d have to do it for everyone.

Patient: Well, what if I take that £8k, voluntarily donate £5k a year to the NHS and use the other £3k to pay for the treatment I need?

NHS: No, you can’t do that. That’s illegal.

Patient: Well, I’m not wealthy, just an average person, but what if I let you keep the entire £8k I give the NHS every year and then try to fundraise some money so I can go to another country for treatment? Some hell hole like Holland or Switzerland that somehow manage to provide better healthcare, where I can get the same or better treatment for just £2k. Would that be OK?

NHS: <Sucks air through teeth> We wouldn’t advise you do that. You wouldn’t like us when we’re angry. We wouldn’t like to have to send the police after you like we did with Ashya King.

Patient: You mean the little boy with a brain tumour who couldn’t get the treatment he needed on the NHS so his parents decided to take him to Spain? Didn’t he survive thanks to the treatment he got abroad?

NHS: We wouldn’t know about that. All we know is they defied the NHS so we had the police issue an arrest warrant for them, and they spent a few days in a Spanish jail. We can’t have parents thinking they know best for their children, now can we?

Patient: But surely the NHS only cares about what’s best for the patient?

NHS: Whatever gave you that impression?

Patient: OK. Well the NHS gets more money every single year. You’re getting an extra £80bn by 2020. Do you think you might be able to give me the treatment I need by then?

NHS: You can’t expect the NHS to spend all that extra money on patient care.

Patient: But I thought spending more money on the NHS meant spending more money on patients?

NHS: Whatever gave you that impression? Where do you think the extra NHS money goes every year? We have to have more and more managers and legions of non-clinical staff on ever higher salaries. That’s progress. You don’t get to be the fifth largest employer in the world by employing doctors and nurses, you know.

Patient: Well, I know the NHS has more than 600 managers who it pays more than £100,000 a year. That seems like an absolute fortune to me. Perhaps these non-clinical managers would be willing to take a 10% pay cut? That would raise at least £6million, enough to pay for my treatment and that of 2,000 other people in the same boat as me.

NHS: I’m afraid we won’t do that. We have to pay these managers lavish salaries or they will leave.

Patient: Where on earth are these people who have mismanaged their hospitals to the point of bankruptcy, who are given £150 billion a year to look after the sick and injured yet run out of money before they get all the nurses and beds they need, who have denied me the treatment I need despite me having paid for it many times over, going to get another job for over £100k a year?

NHS: Somewhere else in the NHS, obviously. Or perhaps on your local council.

Patient: I give up. Perhaps I should just die quietly, would that suit you?

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34 Comments

Mike Newland
on November 23, 2018 at 12:39 pm

The huge and gaping flaw in all this is the post-war mindset post antibiotics in particular that health comes from a doctor. No doctor no health. If that were true healthcare is doomed since we can never afford it. Happily it in the main does not. It comes from your own body and lifestyle. People are just not bothering in the main about the latter and leaving it all to the doctor. Yes a proportion cannot be helped without doctors but that is affordable.

The only hope is to get off the medical train and as far as possible secure your own health. Yes I know about your Uncle Bob who ate right, exercised and dropped dead at 40. We are working on averages here not personal guarantees.

A sensible policy for UKIP would be to say the NHS is not an efficient system but people must do far more for themselves. Unhappily the public largely ain’t listening. A fix of the doc is now akin to the right to an air holiday and beer.

Yes I have really needed the doc miself like and damn glad of the techniques available nowadays. But most treatment is not of this sort and actually discourages looking after oneself. I also note how much illness is self-limiting given the chance and without the conveyor belt of endless medication.

I recommend James le Fanu’s book The Rise and Fall of Western Medicine.

Tacitus
on November 22, 2018 at 9:41 am

Health is partly a lottery and partly something you can control. For the lottery part, insurance is the way society deals with it, insurance inevitably means a lot of people will pay into the scheme but never take from it, whereas a small number of people will take a lot because they are unlucky enough to be born with severe problems. So even if you pay in say £2,000 a year you can only expect to get back say £500 every year while you are young and healthy, and then more as you grow older, but never the full £2,000 as there are many people who don’t pay in and you have to cover them, too. The NHS was intended to be funded by National Insurance for this purpose, that’s why they are called National Health Service and National Insurance, but not merged. National insurance makes sense, although it does not follow that there then is a single provider of healthcare like the NHS. You can have a national insurance scheme with healthcare delivered through private providers. By having a single monolithic provider all innovation is lost, because there is no competition and no penalty for failure, and no incentive to improve. Furthermore a single monolith creates a ‘centrally planned economy’ mentality where the customer has to fit into the NHS’ production schedule. You have to fit in to their timetable, not the other way round. So you end up in situations waiting months for treatment in the NHS when you can literally get the same surgeon to do it tomorrow if done privately. So the problem is not the ‘capacity’ of the surgeons (indeed, if being paid privately you will find they get very creative and work late into evening, weekends, give you their mobile numbers, etc) , the problem is the amount of money in the NHS and the efficiency of the spend.My own personal experience suggests it is hugely inefficient but a lot of the cost of inefficiency is pushed back onto patients. For example, if you go to a GP, they might want you to get blood tests done. But a GP surgery can’t do this, so they have to book you in at a hospital, maybe a week later. Then you do it and maybe get the results 2 weeks later. Who knows how much more your health is being damaged during the wait. If the primary care was hospital based you could do blood test immediately and get results back the same day. Frankly a huge barrier to efficiency is primary care (GPs) as in most cases pharmacists can do what a GP can, whereas GPs also cannot do what pharmacists cannot do (neither GPs nor pharmacists can do bloods, scans, etc). Personally I think primary care needs to be totally reconstructed and become more hospital-based so that diagnosis are complete and done as fast as possible instead of wasting weeks of time.

Barry Davies
on November 21, 2018 at 10:27 am

They have to spend all that money to privatise the nhs as required by Eu procurement regulations, you can’t expect them to treat patients it could cost the private companies money.

Lets be honest every and I mean every health care system rations the health care you get in some way or other.

A social healthcare system, like the NHS, that has to balance the books, rations your healthcare based on what IT can afford.
A fully privatised health care system rations it by what YOU can afford in either your insurance payments or payment at point of service if no insurance available.
Mixed systems will ration based on what the system can afford added to what you can afford to pay for.

Now lets stop all the crap and be honest, it is time for politicians to tell us exactly how much it would cost each of us in tax for the NHS to have all the latest care, medication and or technological, when needed just the same as a billionaire would be able to get paying his extortionate medical insurance premiums each month.
I will be honest I won’t be holding my breath for this information.

Snow Elephant
on November 20, 2018 at 5:48 pm

You know what the say about the average, me and my dog we have on average 3 legs. If you work on minimum wage 8 h daily, 5 days a week and 52 weeks a year you will earn £16,286.4, the average salary is about £27,000. If you decide to exempt “Health Tax” bit (and this will be difficult as there is no specific tax for it) and allow to spend it individually there will be a lot of people that even GP visit may became financial hardship, not mention even more costly issues.
Also you have to bear in mind that the highest costs of health are at your senior years when you retired and our basic pensions not greater in the world.
How about people on welfare not only not working but often disabled?
Your proposal would be beneficiary to young, well earning and good looking and worse for pretty much all the rest.
It will not be that simple or painless but I do agree that the alternative is inevitable collapse of the system.

Snow Elephant
on November 20, 2018 at 5:51 pm

Apologies, this is my comment to Tomaž Slivnik’s about “keep this money instead and spend it on free market healthcare”.

Snow Elephant
on November 20, 2018 at 2:29 pm

NHS as every socialistic invention will work for limited period of time (until we run out of the money). The more burning question is how to “fix it” or at least extend its agony?
For me it is obvious – take the services out of hands of the incompetent government and allow free market to handle it. For some strange reasons I heard on branch meeting (when I was a member) this would be a political suicide in the UK. Have we ever had a veterinarians protests?
The less effective but probably saving a lot of money would be abolishing the existence of trusts and full standardisation across the whole NHS.

MIKE MAUNDER
on November 20, 2018 at 1:38 pm

Don’t misunderstand me. – There is much room within the NHS for targeting money, where it is needed ! ….. However I have been in Northampton General Hospital four times now for operations, and I will balance the comments by saying that the operations were a total success, and the level of care from the Staff was way beyond good. It was exemplary ! Thank you Northampton NHS.

I’m glad someone (other than me getting myself hoarse in private communications) has finally broken the taboo and called the Emperor naked.

The UKIP has taken the wrong side of the NHS argument and our policy for the last few years has been repugnant to the principles of our Party Constitution.

This splendid article sums it up perfectly.

Not just Ashya King but also Charlie Gard, Alfie Evans and undoubtedly countless other children whose stories have not been reported publicly.

Not only is government money always wasted on fat cat bureaucrats rather than people doing real work.

It is axiomatic that no system of service provision where the price at the point of use is zero has to eventually collapse under its own weight, since demand at zero price is infinite. Instead of allocating the limited resources via the price mechanism (which does a pretty good job at allocating most of the resources to those who have a real problem and are thus more likely to pay more) it allocates them via bureaucratic rationing (i.e. according to arbitrary rules cobbled up by bureaucrats and politicians, in corrupt ways, and to those who scream the loudest and are the least responsible while turning away and letting down people with very serious problems, and who contribute the most to the financing of the system, in the most horrific of ways). In time, those who recognize this now will be proven right. So why do we insist on being on the wrong side of the argument with all the other social democratic political parties who will eventually be exposed as having been wrong all along?

In the free market, the price of a GP visit would be about £30-£50 (this is what it is where indeed the private market operates — I can give at least one such example, which is Sark). Even a private GP in Harley Street is about £100. Anyone can afford to pay that out of their own pocket. But people who visit their GP just because they are feeling a bit lonely (as many do now and clog up the system while seriously ill people can’t get an appointment) would then think twice before doing so (and that’s not to say that lonely people do not deserve help, but does it really have to come from someone with the scarce and expensive skills of a qualified doctor?)

Snow Elephant
on November 20, 2018 at 3:30 pm

Empowering privatization of NHS on example of GP visit is a bit too simple for my liking. Few examples from NHS reference costs (https://www.gov.uk/government/publications/nhs-reference-costs-2015-to-2016):
Lung Transplant £32,674.41 (191 operations in period)
Cardiac Arrest with CC Score 9+ £2,291.93 ( 1,593 operations in period)
Standard Repair of Aortic Root with CC Score 0-6 £12,657.20 ( 208 operations in period)
Brain Tumours or Cerebral Cysts, with CC Score 11+ £7,597 (operations in period)
These are not cheap procedures by any means and on free market they would be cheaper but not affordable without insurance.
I am in favour of privatization but it will be pretty complex to deliver it.

I was not aware of these numbers but I refer to the original article which argues that the average household tax bill is £25,000 and that a third of the entire tax take is spent on the NHS (I have not checked either your numbers or those in the article independently, but they seem about right, so I will assume in what I say that they are all correct). In this context, these numbers aren’t large at all. According to these numbers, the average household spends on the NHS the cost of one brain tumour operation every year, the cost of a lung transplant every four years, or the cost of one cardiac arrest treatment every 3 months. How does that compare to the value the average household gets from the NHS every year? Does this seem like even vaguely value for money? And like you say, that is at the inefficient public sector prices. What if the average household was able to keep this money instead and spend it on free market healthcare as and when needed? I agree that getting the government out of healthcare will be difficult, but the primary problem is political, not operational. Eventually it will just happen because the whole system will collapse under its own weight. Can you imagine that a third of the entire tax take is being spent on socialized medicine? That is absolutely astonishing and absolutely abominable. And likely to get worse. And yet, people are unable to get necessary treatments because they are rationed and have to wait so long for cancer treatment they die before they get their turn. That is absolutely bonkers.

Brenda Rattle
on November 20, 2018 at 4:27 pm

Hello Tomaz

I wonder if you are erring on the side of caution when you say a private GP appointment is £30 – £50. Back in 2012 when I was living in Wales a GP (NHS) refused me a referral for private treatment – I had health insurance at the time.

I had to make an appointment with a private GP just to get a referral. That private GP cost me £75 – health insurance doesn’t cover private GP appointments. I imagine it’s even more now.

In Harley Street, the actual prices today are £100-£150, but that is a gold-plated diamond-encrusted service. The service level is: you walk in and you are seen immediately, without making a prior appoitment and without waiting (0-2 minutes waiting time between the time you walk in and the time you are sitting in front of a doctor).

The service level of the £30-£50 services is very similar, but you may have to wait a few more minutes (nothing like at an NHS GP though).

This web site: https://www.medicspot.co.uk/pricing advertises private GPs in the UK today for £39 per visit (or you can have all you can eat private GP access for £150 per year). I have not tried their service.

I totally believe that you paid £75 for your private GP appointment. This is how the free market operates: price levels, and service levels, vary. A higher price does not always guarantee better service. The opportunity to research the various options, and the choice, is yours.

How long do you have to wait to see a “free” NHS doctor? How much is your time worth to you? How long do you have to wait to get an appointment? How much is your health worth to you?

In my experience also, private GPs will prescribe more modern (but more expensive) medications which the NHS will just not prescribe (even if you are willing to pay for them).

Brenda Rattle
on November 20, 2018 at 7:37 pm

I had good reason to go private for GP appointment. I have no complaints about the level of service – the private GP was brilliant as she advised me on my health concerns as well as giving me the referral.

I was simply pointing out that it can be more expensive than you suggested. I certainly didn’t have time to shop around as suspected cancer is terrifying.

I don’t feel that the costs in Sark or Singapore are relevant if a patient lives in England as I doubt anyone would travel that far for a GP consultation.

Just to clarify what you are saying: that you were very happy to pay £75 for your private GP appointment because you had a potentially very serious illness? But if your illness was less serious, you might have taken the time to do more research and find a cheaper alternative? And if your concern was not serious at all, you might not have gone to the doctor at all if you had to pay?

Also, that the NHS let you down by refusing to refer you, while a private GP gave you a good service and the referral you were looking for, for a reasonably modest sum?

See where I’m going with this?

The price on Sark and in Singapore are relevant, because they are all much the same as the prices I found you on that web site in the UK as well (all within the £25-£50 range). So this is about what this service costs in the free market across much of the developed world. In the developing world, it will be less.

Brenda Rattle
on November 21, 2018 at 8:03 am

Mr Slivnik

To clarify: I said that I paid £75, I did not mention the word ‘happy’. What I might have done in other circumstances is pure speculation on your part. I do not indulge in speculation but deal with a given situation if and when it arises.

I wasn’t speculating, I was asking for you to clarify what you were saying.

You said that the private GP was brilliant and that you had no complaints about the level of service. You said you were terrified and the NHS refused to give you a referral, while the private GP solved your important problem by giving you one. You could have shopped around and got a cheaper (<£40) private GP, but you didn't. I therefore asked you whether you were saying you were happy to pay the private GP the £75. It's not an unnatural or unreasonable question. From your answer I can see you're either unwilling to answer, or that you were unhappy to pay. Most people are happy to pay a modest sum for an excellent service which may have saved their lives, even if you are not. The NHS let you down, the private GP provided you an excellent service for (what most people consider to be) a modest fee in the circumstances. That is my point.

You also said that you didn't have the time to shop around because cancer was terrifying. I therefore asked you whether you would have shopped around for a cheaper alternative if you had a less serious, less urgent and less terrifying illness. Again, it's not an unnatural or unreasonable question. It seems that you don't want to answer it, but I can tell you that is how most people would react. And that is my other point.

Also, most people are unwilling to pay £75 or £40 to waste a qualified person's time because they are feeling a bit lonely. They'll find someone else to talk to who doesn't cost as much. That is my third, and final, point.

"I don't indulge in speculation" is a lawyerish answer. Laws and political decisions must be made in such a way to have a sensible outcome even in future situations which haven't happened yet. If you do not have the ability or the willingness to reason about common scenarios that are affected by a policy other than your own very specific situation, I respect that, but if that is so, why do you feel you have something useful to contribute to a political discussion?

No, legally they can’t refuse. However, they get points for each NHS referral and those points get them oodles of extra cash for the GP practice – so it’s in their own interests to steer a patient to an NHS hospital. I didn’t know all that at the time.

It wasn’t an outright refusal. Rather that the GP ignored my requests to go private and kept on about how wonderful hospital X was and that the consultant was, I quote, “clinically lovely”. I’d been coughing up blood and was being referred for suspected lung cancer. I was petrified and very vulnerable so it was easy for the GP to refuse a private referral but in a roundabout way.

Consultant was a pig of a man. I was also made to have a junior doctor sitting in the consultation despite telling them three times that I didn’t want her there. Reception and nursing staff were rude and unhelpful. After seeing the consultant (he was Maltese) who insisted he would be doing a brochoscopy the following day I ran out of the hospital in tears. He’d convinced me I had cancer just on the basis of one symptom and before any tests.

Contacted BUPA next morning to check they would cover me if I went private, and then cancelled the NHS test. I found a consultant who suited me – my main criteria being that he/she had to be English. Anyway, he was brilliant and, thankfully, nothing significant was found.

I did complain about the NHS fiasco but NHS don’t take it seriously unless the complaint goes via a solicitor – and who can afford that?

Kind regards.

Stout Yeoman
on November 20, 2018 at 4:38 pm

An average earner loses around 46% to 49% of his or her income in taxation (from airport and fuel duties to VAT, NI, stamp duty etc etc) depending on spending patterns. He or she cannot envisage paying for health insurance. We need to reduce the burden of taxation and allow people to keep more of their own money (and reduce costs of essentials like food and energy by leaving the EU and stopping excessive green taxes). If people have more disposable income then health insurance becomes realistic for them and so privatisation becomes politically possible. Choice and competition is the solution. Self-serving, state funded monolithic bureaucracies are definitely not the solution.

Uncontrolled population growth is a major factor in pushing up NHS costs. Net immigration is a city the size of Newcastle every year. That means the country needs at least two hospitals and over 220 GP surgeries every year as well as supporting ambulance service and medical laboratories etc. Every year. (Newcastle has 220 GP health centres feeding two hospitals).

Private companies adapt and grow with their markets. The rate of population growth would not matter in a fully privatised system. The newcomers would have to pay like everyone else. No freeloaders as present. (I’m opposed to open borders for cultural and political reasons not because, or not just because, uncontrolled immigration is a burden on the NHS which it is of course).

Social care of the elderly is a large and growing burden on the state and NHS. We need to move to a culture of self reliance. It is up to me, surely, how much provision I make for my old age (once taxes are down and discretionary income goes up). I should not be able to live a dissolute, frivolous life of booze and gambling and then expect you to pay later for my injudicious choices. The transitional problem is that people feel they have made provision in the form of NI payments. The change will need to be managed by first merging income tax and NI (as Osborne once planned to do). After a few years of that, as taxes come down, the culture change can begin.

I was ill in Singapore a few years ago. I obtained, out of the blue as it were, a GP appointment within 15 minutes and a short walk from my hotel. At the end of it I collected my prescription from the receptionist on the way out – no need to go search for a pharmacy – and it was a 30 minute appointment not the rushed 10 minutes you get on the NHS, The total cost including drugs was £31 (at the then exchange rate) which I very happily paid. Had I needed hospital treatment I would have been spoilt for choice among world leading state of the art hospitals.

UKIP’s constitution mandates pursuit of a smaller state and lower taxation. If only the party was faithful to its constitution. But red UKIP v Blue UKIP is back.

Your experience in Singapore matches mine exactly. I also got an appointment very rapidly, the doctor was amazing, I got the medication at the doctor’s surgery and the cost was very reasonable. I could not remember the cost (because this happened in 1993/1994), so I looked it up (see my other comment with the link) and the price I found on the Internet matches yours perfectly!

Tacitus
on November 21, 2018 at 10:00 am

Just for a price update – I usually go private rather than see GPs who have no idea what they are talking about. If you go private and self-pay it generally costs £200 – £250 to be seen immediately by a consultant who is specialist in the area. That is outer London price, and GP might be a lot cheaper, but why go to see a private GP, they are just as bad as NHS GPs. On the other hand, if you go through the NHS, you can wait 7-14 days for the GP, who may or may not refer you to a ‘specialist’ (normally someone working under the consultant, not always the consultant) and if you are lucky you might get to see them in 1-2 months. They will then diagnose you and if you are lucky you might get treated in 1-3 months. For all the stress, delay, deterioration in health in the meantime, I spend the £200.

I agree with you entirely. Yes, good specialists charge in that price range. A private GP can be useful for vaccinations, when you need a referral (which even some private specialists and services, e.g. MRI, seem to ask for), when the problem is either simple or common enough (e.g. a bacterial respiratory infection – you need antibiotics), when it’s not clear what the problem is and who the right specialist is to see, etc. Some GPs indeed are clueless, but some are very good, including at identifying and treating more complex things – although the right specialist will normally be the best to see for his area, of course. You need to keep your brain in gear, assess whether the advice given makes sense, and get a second opinion when in doubt.

I have a funny story about dentists. I had to get four opinions once before getting the correct diagnosis. If I had gone along with any of the first 3, they would really have screwed up my mouth. That was many years ago and I now have the benefit of hindsight. Not only would it have been way more expensive in the long run not to get the other opinions, it would also have significantly damaged my health.

How much control over your own life and health does socialized medicine give you? Perhaps we should ask Ashya King, Charlie Gard and Alfie Evans.

I first learned that private is cheaper when I was a poor graduate student. I visited an NHS A&E. After a 4 hour wait, I was told I’d have to wait probably another 4 hours. I was scared and went to a private hospital. It turned out I was right to worry. They charged me £120 and solved my problem. I did not have to wait 5 minutes to be seen. Graduate students were paid £30/hour then to teach undergraduates. 8 hours at £30/hour or £120 – how much is your time, and your health, worth?

Euge power
on November 20, 2018 at 12:45 pm

And the NHS managers. Nearly all jumped up union reps. When my dad was in hospital there was an ad for a union meeting . Agenda item was cleaning bedpans and patients. This was in the Middlesex Hospital, run by aforesaid jumped up union rep.. Since the jumped higher to Northwick Park

Euge power
on November 20, 2018 at 12:37 pm

What was first envisaged for the NHS ? Creating a huge beaureacracy where none existed before ? Creating loads of jobs for Labour Party layabouts ?
Or filling the doctors mouths with Gold ?-see Nye Bevan

Tacitus
on November 20, 2018 at 11:13 am

Very good! Unfortunately UKIP has gone through a policy reversal and is now fully behind the NHS! The NHS not only delivers poor healthcare (how many stories does every family have of how the NHS has let them down) but is also a socialist redistribution of wealth scheme AND the biggest source of trade union members and subs to the Labour Party. It also encourages this attitude of ‘someone should take care of me’. UKIP is supposed to be the party of self-reliant individuals, people who strive to take care of themselves. The new interim manifesto has a section about the NHS which basically accepts its continued existence and tinkers with it to try to improve it in its current form. Basically indistinguishable from Labour, Tories, Limpdems. This is out of a misguided attempt to win elections under FPTP (not going to happen!). We should be a unique, different voice bringing people independent policy alternatives, not just aping the status quo establishment. How can it possibly be that every political party in the UK basically supports an institution that delivers worse healthcare outcomes than the alternative systems in most other developed countries? Where is the diversity of thought?

Roger Turner
on November 20, 2018 at 9:25 pm

I don`t think it was always so, I seem to remember Nigel was all for some sort of private insurance scheme, until he swiftly reversed his position when the MSM got hold of him prior to an election and he was quickly persuaded that bird was so toxic that it couldn`t fly.
I know the biggest current problem with the NHS stems from its own success and unrestricted numbers of additional immigrant users for who no special provision has ever been made, but the biggest problem came around 1975 when they started to undertake social services or care in the community, which up till then had largely been on an ad hoc charitable basis, I don`t think governments of all persuasions have ever had the faintest idea of the scope the services would have and the number of requirements there would be for only vaguely medical services and the modern trend to “quality of life” considerations,
AND Loads and Loads and Loads and Loads of immigrants – I`ll bet with little adequate provision.

The whole thing is overloaded, under resourced, b*ggered around purely for political points scoring from its inception, in effect it has been unloved by both users and politicians who have never had a clue how to handle it. No one is prepared to admit it is impossible to save in its present form.

One thing I do know it will be a drain on the state forever, a running sore and there may be the will to fix it once and for all by someone, but a mixture of PC and inertia will never let it happen – even when it eventually it drains the country dry and founders.

Grumpyashell
on November 20, 2018 at 10:29 am

When talking to anyone about the NHS I always ask one question…. if the NHS is the envy of the world can you name me the countries that have used it as a template for their health services ?…..they cannot answer because there are none and those that have gave it up

The NHS as first envisaged was a great idea but it has been captured and laid low by parasitic politicians and bureaucrats.

I recall a couple of years ago at the JRH buying a coffee at the Friends. This facility is run by volunteers and proceeds given to the hospital trust . Ahead of me in the queue was a hospital administrator, I know this because he had some hospital files under his arm.
Coffee at the Friends was inexpensive i.e. £1 a cup nevertheless this gentleman asked for a receipt so I guess you and I were going to pay for his coffee.

Snow Elephant
on November 20, 2018 at 2:32 pm

How it was a good idea? “From each according to his ability, to each according to his needs” as a great idea too, the issue is it will not work in real world with real people.